Category of service or resource available in a location.
Examples include but are not limited to hospital, laboratory, pharmacy, ambulatory clinic, long-term and post-acute care facility, and food pantry.
Submitted By: Keith W. Boone
/ Audacious Inquiry
Data Element Information
Use Case Description(s)
Use Case Description
Facility level data is associated with laboratory tests (the testing facility), and health care provider locations, including hospitals, ambulatory providers, long-term and post acute care, and pharmacy providers.
Location data is used to support reporting of data for public health and emergency response (e.g., situation awareness reporting).
See https://build.fhir.org/ig/HL7/fhir-saner/ for details (note that (minus) - is a legal character in URLs, had to use a bit.ly link to get past validation errors in URL)
Estimate the breadth of applicability of the use case(s) for this data element
Hospitals in the US (Approximately 7000), Laboratories (260,000), pharmacies (88,000), ambulatory physicians (260,000).
5 or more. This data element has been tested at scale between multiple different production environments to support the majority of anticipated stakeholders.
Restrictions on Standardization (e.g. proprietary code)
None
Restrictions on Use (e.g. licensing, user fees)
None
Privacy and Security Concerns
Locations associated with Critical Access Hospitals, and single provider facilities may constitute PHI (in geographic locations with limited populations) and/or Individual Identifiable Information (e.g., for HCPs working from a combined home/office facility).
Estimate of Overall Burden
Most electronic systems provide the capacity to store location and organization information. Many EHRs already provide access to the Location resource via READ operations, some (e.g., Epic, AthentaHealth) provide search capabilities as well. This information is routinely communicated in HL7 V2 Messages, CDA Documents and some FHIR API transactions. To address gaps, implementers would need to modify interfaces (e.g., for CDA or HL7 V2), or add an endpoint. Estimated effort (based on past experience building EHR systems) is about one two-week sprint to implement the capability by a developer.
Other Implementation Challenges
Standards for location identifier may need flexibility depending on use of Location for reportiong, as there are a number of distinct location identifier systems which may be necessary for different reporting use cases. For example, CDC/NHSN assigns identifiers for HAI reporting, CLIA assigns identifiers to laboratories, CMS provides location identifiers, et cetera.
CDC and CMS agree that facility type should move forward as part of USCDI V4. The facility type element complements existing USCDI data elements, particularly “encounter location”, and provides contextual information for surveillance, compliance, and public health action. For example, information on facility type can help facilitate work to improve health equity by supporting efforts to identify, characterize, and take steps to respond to evidence of decreased or restricted access to care, inadequate care quality, and adverse outcomes.
However, we also recognize that applicable standards for facility type vary in terms of granularity, maturity, breadth (examples include NUCC Healthcare Provider Taxonomy—Non-Individual; NHSN Facility Type; FHIR Location). To that end, we recommend that ONC also work with CDC, CMS, and other key healthcare and public health stakeholders to identify and evolve appropriate standards for Facility Type. Importantly, standards for facility type should be defined in ways that maintain clear differentiation from “encounter location” and associated standards.
Shared priority for CDC, CMS, and ASPR (via all hazards work with CDC)
Why Facility Type Is Important: The facility type element provides contextual information for surveillance, compliance, and public health action. For example, facility type has been used during the COVID-19 response to set hospital reporting requirements and contextualize reported data on hospital burden and capacity. In addition, information on facility can help facilitate work on data equity. Some examples include different kinds of healthcare facilities (e.g., acute care hospital or SNF), correctional facilities, facilities that primarily serve people experiencing homelessness, and federally qualified health centers. When coupled with healthcare service and outcome data, we are better able to identify, characterize, and take steps to respond to evidence of decreased or restricted access to care, inadequate care quality, and adverse outcomes. Importantly, facility type complements existing USCDI data elements, particularly “encounter location”. One way to think about facility type vs. encounter location is that facility type is a “gross” characterization, like hospital, prison, SNF, or homeless shelter; encounter location, by contrast, is a more granular characterization of where services were delivered within that physical location (e.g., a trauma unit in an ACH, memory care ward in a SNF, infirmary within a prison). Another way to differentiate the two is by information use/purpose: Facility type can be thought of as a structural or administrative classification—it’s part of the “package” of electronic meta-data under discussion here and provides useful information for regulatory, payment, and certain healthcare quality and public health related actions. Encounter location is more functionally/clinically focused and more granular—as such, supports more nuanced distinctions of where care is provided and how that location “functions” that support quality measurement and improvement, as well as public health surveillance and situational awareness reporting purposes.
Additional use case: hospital COVID-19 reporting:
As noted above, CDC and CMS agree that facility type should move forward as part of USCDI V4. However, we also want to recognize that applicable standards for facility type vary in terms of granularity, maturity, breadth (examples include NUCC Healthcare Provider Taxonomy—Non-Individual; NHSN Facility Type; FHIR Location). To that end, we recommend that facility type move forward with commitment to continue development, maturation of applicable standards for Facility Type Be defined in ways that maintain clear differentiation from “encounter location” and associated standards.
Comments from NACCHO: NACCHO supports the inclusion of the facility type as the new data element. However, it recommends creating a standardized common table of facility types that can be used by agencies.
Comments from CSTE: CSTE agrees with CDC's recommendation for this data element.
Additional Use Case: This is a standard data item used by central cancer registries in all states. Data received through data exchange from medical facilities (e.g., laboratories, hospitals, physician EHRs, etc.) to central cancer registries for CDC and NCI’s national cancer surveillance systems, as required by law.
CSTE supports inclusion of this measure into USCDI v3: Very useful for this information to be captured in some way and then subsequently used in reporting to PH.
Submitted by pwilson@ncpdp.org on 2023-04-17
NCPDP Comment
NCPDP recommends the adoption of taxonomy codes to identify the type of facility.